Creating and maintaining optimal peritoneal dialysis access in the adult patient. We will discuss them in detail in the next two slides. The incidence of peritonitis in peritoneal dialysis pd patients has decreased as a result of improvements in pd technology. Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients. Fulltext pdf 107 pasteurella multocida peritonitis in a patient on peritoneal dialysis. The present recommendations are organized into 5 sections.
P eritonitis remains a leading complication of peritoneal dialysis pd. Clinical practice guideline peritoneal dialysis in adults and. Standard antibiotic regimens target common causative microorganisms such as staphylococcus aureus and epidermidis or pseudomonas aeruginosa. Mar 20, 2016 society for peritoneal dialysis ispd were first published in 1983 and revised in 1993, 1996, 2000, 2005, and 2010 914. Peritoneal dialysisrelated infection rates and outcomes. Peritonitis is a common and severe complication in peritoneal dialysis pd. In some outstanding centers, peritonitis rates as low as 0. A total of 9,452 pdrelated peritonitis episodes occurred in 4,624 incident pd patients in australia during 2004 through 2014. Peritonitis was independently associated with higher ri sk of allcause, cardiovascular and infectionrelated mortality in peritoneal dialysis patients, and its impact on mort ality was more significant in patients with longer peritoneal dialysis duration. Article pdf available in peritoneal dialysis international. Peritoneal dialysis pdrelated infection encompasses pdrelated peritonitis and catheterrelated infections, and the latter is used as the collective term to describe exit site infection esi.
Renal association clinical practice guideline peritoneal dialysis june 2017 2. Peritoneal dialysis peritonitis with zoonotic organisms is an increasing medical concern and poses potential serious problems. Peritonitis is associated with significant morbidity, catheter loss, transfer to hemodialysis, transient loss of ultrafiltration, possible permanent membrane damage, and occasionally death. Salim mujais,8 and enrico verrina,9 for the international society for.
Prevention of infectious complications in peritoneal dialysis. Peritonitis is a common complication of peritoneal dialysis. Peritonitis was independently associated with higher ri sk of allcause, cardiovascular and infection related mortality in peritoneal dialysis patients, and its impact on mort ality was more significant in patients with longer peritoneal dialysis duration. Recommendations under the auspices of the international society for peritoneal dialysis ispd were first published in 1983 and revised in 1993, 1996, 2000, 2005, and 2010 914. Ispd position statement on reducing the risks of peritoneal dialysis related infections 2011 peritoneal dialysis related infections recommendations 2010 peritoneal dialysis related infections recommendations 2005. Antifibrotic effect of decorin in peritoneal dialysis and. Although less than 5% of peritonitis episodes result in death, peritonitis is the direct or major contributing cause of death in around 16% of pd patients 16. Peritoneal dialysisrelated eosinophilic peritonitis. Around 18% of the infectionrelated mortality in pd patients is the result of peritonitis. Preliminary data from the peritoneal dialysis outcomes and practice patterns study pdopps have revealed striking.
Peritonitis has been the most common complication of continues ambulatory peritoneal dialysis capd since it was first implemented, and it remains the leading. Peritonitis can be associated with pain, hospitalization and catheter loss as well as a risk of death. Treatment of peritoneal dialysis pd related peritonitis page 1 of 7 wa home dialysis program wahdip guidelines general principles 1. Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis 2005. Bacillus subtilisassociated abdominal catastrophe in a. As the most common complication, peritonitis prevented peritoneal dialysis from becoming more widely used. Ispd peritonitis recommendations peritoneal dialysis international. Although less than 4% of peritonitis episodes result in death, peritonitis is a. Demographic characteristics and outcomes of continuous. The detection of peritoneal calcification on ct is rare but potentially of major clinical importance because such findings have been associated with primary and secondary peritoneal malignancies 1, 2, as well as with benign causes such as sclerosing peritonitis due to peritoneal dialysis 3, 4, peritoneal tuberculosis, prior meconium peritonitis, hyperparathyroidism, pneumocystis. You can get an infection of the skin around your catheter exit site or you can develop peritonitis, an infection in the fluid in your belly. Center effects and peritoneal dialysis peritonitis. The majority of patients could not resume pd 1,2, and the. Mortality directly related to peritonitis is low, but peritonitis episodes cause psychosocial problems and.
Clinical manifestations and diagnosis of peritonitis in. Peritoneal dialysis pd related infections, such as peritonitis, exitsite infection, and tunnel infection, are serious complications to patients with pd. Inconsistencies in ispd peritonitis recommendations. However, peritonitis episodes of which the causative pathogens cannot be identified may lead to refractory peritonitis, a condition of failure to clear up leukocyte in the pd effluent after 5 days of appropriate antibiotics. Complications of continuous ambulatory peritoneal dialysis. Infectious peritonitis is still a major concern in peritoneal dialysis pd. Understanding the immune signature fingerprint of peritoneal. Centre deviations from the international society for peritoneal dialysis ispd peritonitis guidelines have been observed to be both common 26, 28 and associated with higher rates of peritonitis and poorer peritonitis outcomes. Pdf peritoneal dialysis is an effective treatment modality for patients with endstage renal disease. Peritoneal dialysis pd related infections continue to be a serious complication for pd patients. Peritoneal dialysis pdrelated infection encompasses pdrelated peritonitis and catheterrelated infections, and the latter is used as the.
An infection can also develop at the site where the catheter is inserted to carry the cleansing fluid dialysate into and out of your abdomen. The new ispd peritonitis guideline renal replacement therapy. Organization of the peritoneal dialysis programthe nurses role, in gokal r, nolph kd eds. Preventing pd related peritonitis and catheter exit site or tunnel infections is a high priority, yet practice patterns to do so vary widely. The patient managed pd well figure 1a,f by himself, and he had to that point experienced no episodes of pd related infection.
We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the peritoneal dialysis outcomes and practice. A general overview of peritonitis in peritoneal dialysis is presented separately. Among peritoneal dialysis patients, infections of the peritoneal space are usually caused by staphylococcal species. Demographic characteristics and outcomes of continuous ambulatory peritoneal dialysis related peritonitis med j malaysia vol 74 no 4 august 2019 271 of peritonitis, antimicrobial treatment, date of catheter removal andor death. Peritoneal dialysis pdrelated peritonitis carries high morbidity for pd patients. The technique of capd was first described more than 30 years ago 1. The relative use of peritoneal dialysis versus hemodialysis varies widely by country. We recommend a periodic questionnaire, an educational session and a home visit at the time of initiation of pd for all pd patients who have or intend to have pets for their social support to prevent pets related.
The new ispd peritonitis guideline renal replacement. Immediate empiric treatment doses must be added to the patients medication chart to be a valid order. Recommendations for the treatment and prevention of pd related peritonitis, and latter those for catheter related infections, under the auspices of the international society for peritoneal dialysis ispd were first published in 1987 and revised in 1989, 1993, 1996, 2000, 2005, and 2010 1,2,3,4,5,6,7,8. Contact the nephrologist or peritoneal dialysis unit covering the patient as. Peritoneal dialysis peritonitis clinical pathway department. Understanding peritonitis related to peritoneal dialysis. Peritoneal dialysisrelated peritonitis treatment recommendations. Your peritoneal equilibration test pet this test is done within 48 weeks after starting peritoneal dialysis. The impact of peritoneal dialysisrelated peritonitis on. Clinical practice guideline peritoneal dialysis in adults. Recommendations for the treatment and prevention of pdrelated peritonitis, and latter those for catheterrelated infections, under the auspices of the international society for peritoneal. When the infection does not respond, unusual infective agents are to be considered including zoonosesinfections with an animal source.
Predictors of peritoneal dialysisrelated peritonitis table 1 ge n e r a l c h a r a c t e rs i tc i s o f t h e p a t ei n t s u n d e r g on i g p e r ti o n e a l da i l y ss i n 330 variables frequency % sex male 168 50. Peritonitis represents a major complication of peritoneal dialysis pd. Peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity, mortality, and health. Peritoneal dialysisrelated peritoneal dialysisrelated peritonitis is either due to contamination with pathogenic skin bacteria during exchanges ie, touch contamination, or to an exitsite or tunnel infection. Although acute peritonitis is a common and severe complication associated with peritoneal dialysis, the culturebased test used as the diagnostic criterion for this disease is often too slow to allow appropriate pointofcare diagnosis of specific bacterial infection. The aim of this paper was to systematically collect data on patient related risk factors for pdassociated peritonitis, to analyze the methodological quality of these studies, and to summarize published evidence on the particular risk factors. Peritoneal dialysis pd related peritonitis due to atypical organisms commonly occur following prolonged antibiotic exposure in an immunecompromised hosts. Impact of age on peritonitis risk in peritoneal dialysis. In addition, severe or prolonged peritonitis leads to structural and functional alterations of the peritoneal membrane, eventually leading to membrane failure. Peritoneal dialysis international the culture from. There are eight key factors in diffusion occurring in peritoneal dialysis. Introduction peritonitis is a common complication of peritoneal dialysis pd and fungal peritonitis fp is almost 330% of all peritonitis 15. Peritoneal dialysisrelated peritonitis caused by pseudomonas. Peritoneal dialysis infection exitsite and peritonitis rates should be monitored and reported for every clinical dialysis program annually.
Peritonitis is a common and serious complication of pd. Peritoneal dialysis, peritonitis, mortality, timedependent variable. Microbiology of peritoneal dialysisrelated infection and. The aim of this paper was to systematically collect data on patientrelated risk factors for pdassociated peritonitis, to analyze the methodological quality of these studies, and to summarize published evidence on the particular risk factors. Ispd position statement on reducing the risks of peritoneal dialysisrelated infections 2011 peritoneal dialysisrelated infections recommendations 2010 peritoneal dialysisrelated infections recommendations 2005. Nevertheless, peritonitis remains a major problem in pd, with a substantial percent of patients developing persistent or relapsing infections. Peritoneal dialysis related peritonitis is an important negative risk of peritoneal dialysis worldwide, with varying prevalence depending upon location. Peritonitis results when organisms enter the peritoneal space, and the immune system in the peritoneum is unable to prevent the proliferation of these.
It is an important part of an integrated service for renal replacement therapy that is. Peritonitis caused by pseudomonas species is a particularly common and serious complication in the asiapacific region, and is often associated with a poor response to antibiotics as well as a high rate of catheter removal 3,4. Risk factors for peritonitis in longterm peritoneal dialysis. Peritonitis is a peritoneal dialysisrelated infection caused by bacteria entering the abdomen from outside the body and infecting the peritoneum. Pdf peritoneal dialysis is an effective treatment modality for patients with end stage renal disease.
Peritoneal dialysisrelated infections recommendations. Towards improving evidence, practices, and outcomes yeoungjee cho, md,1,2 and david w. Generally, intraperitoneal ip medication administration results in high ip drug levels and is considered the preferred route of antimicrobial administration for pd catheter related peritonitis to achieve maximum drug exposure at the. A rare bacterial and fungal peritoneal dialysis related. The cause of eosinophilic peritonitis is obscure, however it may be related to some etiologies. Petrelated peritonitis and its prevention in peritoneal. Peritoneal dialysisrelated peritonitis with klebsiella. Current treatment guidelines emphasize the use of intraperitoneal antibiotics and onceaday administration of aminoglycosides. Very low rates of peritonitis in a program are possible if close attention is paid to the causes of peritonitis and. The diagnosis of pd peritonitis was made when at least two of the following were present. Peritonitis is a major cause of pd technique failure and conversion to longterm hemodialysis 1,5,7,8.
Excluded from the analysis were 167 patients 4% of patients having peritonitis with missing demographic data and 29 patients 0. One of the most serious problems related to peritoneal dialysis is infection. Peritoneal dialysisassociated peritonitis american. Peritoneal dialysis pd is presently used by 170,000 endstage renal disease esrd patients worldwide, representing approximately 8% of the total dialysis population. Peritonitis remains the archilles heel of peritoneal dialysis pd and is the major cause of technique failure 1,2. Bacteria may enter the body through the open ends of the pd catheter during exchanges.
Risk factors associated with peritonealdialysisrelated. It tells how your peritoneal membrane is working and helps your doctor decide how many exchanges you. Abdominal catastrophe in patients with peritoneal dialysis pd is a condition in which visceral injury may cause leakage of enteric microorganisms into the peritoneal cavity, resulting in. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention strategies. A 56yearold taiwanese man with endstage renal disease secondary to diabetes mellitus had been on continuous ambulatory peritoneal dialysis pd therapy for 3 years.
Detailed recommendations on the prevention and treatment of pdassociated peritonitis have been published by the international society for peritoneal dialysis ispd, but there is a substantial variation in clinical practice among dialysis units. Bacteria can enter your body through your catheter as you connect or disconnect it from the bags. Reducing peritoneal dialysisrelated peritonitis rate. Prophylactic antibiotics administered before pd catheter insertion. The peritoneal dialysis and outcomes practice patterns study pdopps is the largest international observational cohort study to collect detailed information in a uniform manner on the incidence of pd related peritonitis and on peritonitis prevention practices and provides a platform for the prospective surveillance of peritonitis. When culture results and sensitivities are known, antimicrobial therapy. Patients with peritonitis usually present with cloudy effluent and abdominal pain. Peritonitis risk is not evenly spread across the pd population or programs. Repeated exposures to conventional peritoneal dialysis pd solutions have been associated with an impairment in host cell defense, 1 reduction in peritoneal mesothelial cell viability, 2 and progressive peritoneal membrane injury. Peritoneal dialysis is an effective treatment modality for patients with endstage renal disease. In continuous ambulatory peritoneal dialysis capd, the dialysate is infused into the peritoneum via an indwelling catheter with the tip positioned in the pelvis, and the peritoneal membrane, a natural semipermeable membrane, serves as the dialyzer. Prevention of infectious complications in peritoneal. Clinical pathways never replace clinical judgement.
Fungal pd peritonitis is a rare cause of pd related peritonitis and is associated with significant morbidity and mortality with poor response to conservative management. Peritonitis is a common and serious complication of peritoneal dialysis pd. Review of antibiotic dosing with peritonitis in apd. Peritoneal dialysisassociated peritonitis american society of. Peritoneal dialysisassociated peritonitis american society. Predictor factors of peritoneal dialysisrelated peritonitis.
Pdf peritoneal dialysisrelated peritonitis treatment. See microbiology and therapy of peritonitis in peritoneal dialysis. Eosinophilic peritonitis in continuous ambulatory peritoneal dialysis capd patients was first reported in 1967. Exitsite and cathetertunnel infections are major predis posing factors to pdrelated peritonitis 31. Until the fall of 1978, peritoneal dialysis solution pd solution was only available in glass containers connected to the permanent catheter with plastic tubes.
Petrelated pasteurella multocida induced peritonitis in. Ispd guidelines international society for peritoneal. Peritoneal dialysis an overview sciencedirect topics. Preventing peritoneal dialysis infections wounds research.
Clinical practice guideline peritoneal dialysis in adults and children authors. Centre effects and peritoneal dialysisrelated peritonitis. An infection of the abdominal lining peritonitis is a common complication of peritoneal dialysis. If so, your doctor may need to change your dialysis prescription or other medical care that you are receiving.
Peritoneal dialysis pd is long established as a major option for renal replacement therapy in patients with endstage renal disease. Dialysis solution volume in 24 hours and utilizing the full 24 hours for dwell time are the two ways to improve the efficiency of peritoneal dialysis. Johnson, phd1,2 peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity, mortality, and health care costs. Peritoneal dialysis pd related infections background. Ispd guidelines international society for peritoneal dialysis.